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毅行者必備的医療知識 何曉輝医生 伊利沙伯医院急症室 樂施毅行者 2010. TW 97 data Injury patterns: 50% muscle cramp ; 25% foot blister Treatment required: 40% massage ; 20% dressing.

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Presentation on theme: "毅行者必備的医療知識 何曉輝医生 伊利沙伯医院急症室 樂施毅行者 2010. TW 97 data Injury patterns: 50% muscle cramp ; 25% foot blister Treatment required: 40% massage ; 20% dressing."— Presentation transcript:

1 毅行者必備的医療知識 何曉輝医生 伊利沙伯医院急症室 樂施毅行者 2010

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5 TW 97 data Injury patterns: 50% muscle cramp ; 25% foot blister Treatment required: 40% massage ; 20% dressing ; 14% bandaging Medication: 50% analgesic balm / counter-pain / turpentine lotion 1 st aid treatment: 25% once ; 10% twice ; 5% thrice

6 TW 2005 data Injury patterns: 42% muscle cramp ; 41% foot blister; 9% sprain, 8% wound Treatment required: 19% massage ; 17% aspiration; 18% dressing ; 37% bandaging; 8% prescription Medication: 50% analgesic balm / counter-pain / turpentine lotion 1 st aid treatment: 25% once ; 10% twice ; 5% thrice

7 Types Muscle cramp Sprain (ankle) Strain Fracture / Dislocation Iliotibial band friction syndrome Blister Wound Management Animal bites Bee sting Snake bite Heat related disorders Heat cramp Heat syncope Heat exhaustion Heat stroke Bandaging and Splinting

8 內容 中暑 低温 外傷出血 骨折 中毒 昆虫咬傷 窒息哽塞 雷殛

9 中暑

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12 Heat Related Disorders 1. Heat Cramp 2. Heat Syncope 3. Heat Exhaustion 4. Heat Stroke

13 Heat Cramps  Painful spasm of muscles  Due to salt depletion  Temperature normal or mildly elevated  Management  Rest in a cool area  Replace water and electrolytes orally

14 Heat Syncope  Post-exertional simple fainting  Due to cutaneous and muscular vasodilatation  Transient hypotension with cold clammy skin  Temperature normal or mildly elevated  Management:  Lying supine with elevation of legs  Cooling  Rehydration with oral fluid

15 Heat Exhaustion  Water and salt depletion  Thirst, weak, nausea, vomiting, pale, cramps even with muscular incoordination and fainting  Temperature elevated but < 39 C  Management:  Lying supine  Cooling  Rehydration with oral fluid with electrolytes

16 Heat Stroke  A life threatening condition  Classical triad:  Core temperature > 41 C  CNS disturbance: obtundation, delirium, seizure  Hot but dry skin  Management:  Cool environment with air movement to encourage evaporation (tepid sponging and fan)  Fluid replacement by IV route (NS)  Admit hospital asap  Panadol and aspirin No Use

17 低温低温

18 徵狀及治療 定義 : <35 0 C 輕度 : 32 – 35C 中度 : 28 – 31C 嚴重 : <28C 作嘔, 嘔吐, 喝睡, 頭暈, 反應遲緩, 脈搏快  慢 更換乾衣, 保暖毛毯, 熱飲, 預防血糖偏低

19 外傷出血

20 Principle of Wound Management 1. Personal Protective Equipment  Gloves 2. Obtain a brief history of injury 3. Conduct a quick assessment of the patient 4. Elevate the bleeding wound, lie the patient down 5. Direct point pressure on bleeding site 6. Prevent heat loss with blankets 7. Take pulse (BP) every 15 minutes 8. Rest and keep fast (may vomit and need surgery)

21 Wound type management Abrasion 1. Rinse with NS 2. Cover with non- adherent dressing 3. Bandage Cut wounds 1. Control bleeding by direct pressure 2. Try to draw wound together 3. Apply gauze dressing 4. Pressure bandage for bleeding control

22 Wound type management Laceration 1. Control bleeding with direct pressure and elevation 2. Rinse with NS and remove dirt when less bleeding 3. Cover with non- adherent dressing 4. Bandage and elevation Avulsion 1. Clean with NS 2. Fold the skin flap back into normal position 3. Control bleeding by direct pressure 4. Apply gauze dressing 5. Pressure bandage for bleeding control

23 Wound Type Management Puncture wound Let the wound bleed freely for a few minutes to wash out bacteria and dirt Stop bleeding with direct pressure Clean with NS Pressure dressing with gauze Impaled object should not be removed to avoid further underlying tissue damage and severe haemorrhage

24 Remove heat source like clothing 1.Rinse with cold water 2.Remove accessories like ring, watch etc 3.Leave blister intact 4.Cover with clean sheet over trunk burn 5.Put injured extremity into plastic a clean bag if feasible Burn wound management

25 骨折骨折

26 Dislocation / Fracture Common sites: Wrist, forearm, ankle, 5 th metatarsal and metacarpal Sign and symptom: Severe pain, tenderness at fracture site Deformity (compared with opposite limb) Swelling + bruise Bony crepitus (bone ends grating on each other) Loss of function of that part of limb Treatment: Don’t try to reduce the fracture / dislocation unless specifically ordered by doctor Splint above and below the fracture / dislocated part Cold compress if possible during transfer to hospital

27 5th Metatarsal Fracture

28 ASIS Fracture

29 Elbow dislocation

30 Clavicular Fracture

31 中毒中毒

32 普遍徵狀 腸臟 : 肚痛, 肚瀉, 嘔吐, 發熱 神經性 : 神智不清, 口唇麻木, 手腳麻木, 膧孔, 心血性 : 脈搏過慢或過快, 體温上升, 冒汗, 分 泌物多 飲食詳情 ( 藥物, 食物, 器皿, 動植物 / 昆虫咬 傷 ….)

33 動物昆虫咬傷

34 1.Rinse with NS 2.Apply cold compress (eg ice wrapped in a cloth) if available to reduce swelling and itchness 3.Cover wound with loose dressing to avoid scratching 4.Remove bee sting with forceps and remember not to squeeze the attached sac Insect Bite (Bee sting)

35 >95% bite = Green Bamboo Snake 1.>20% bites are dry bite 2.Venom: i.Viperidae – mainly cytotoxic, vasculolytic & haemotoxic ii.Elapidae – mainly neurotoxic iii.Hydrophiidae – rhabdomyolysis iv.Colubridae – localised painful swelling, DIC syndrome can occur Snake Bite

36 Snake Bite (Pre-hospital Care) 1. Rest and reassure that immediate fatality very rare 2. Remove constricting things (eg ring) from limb 3. Clean with NS gently and cover with light dressing 4. Immobilise the injured part in a dependent position below heart level 5. Apply a firm board bandage over the injured area and most part of the involved limb. The banadage should be tight enough to occlude lymphatic flow but not to impede venous or arterial flow. Distal digits should be exposed for circulation check. 6. Monitor distal circulation by checking pulse, colour 7. No tourniquets, local application of herbal medicine 8. No drink nor alcohol

37 窒息哽塞

38 微狀 双手抓著喉部 不能說話 臉色變藍 頸臉靜脈 ( 青根 ) 突現 不省人事

39 急救 鼓勵咳嗽 推腹法 (6 -10 次 ) 不省人事 食指清理气道

40 雷殛雷殛

41 分類 低伏特 : <1000V 高伏特 : >1000V 交流電 直流電

42 微狀 雷電天气下 : 受傷 ( 燒傷 ), 昏迷, 呼吸停止 Direct strike - 最嚴重 Side Flash - 最常見 Ground Strike Blunt trauma ‘Flashover’ phenomenon

43 雷殛引致的傷害 燒傷 - 衣服, 身上的金屬 ( 如頸鍊 ), 通常輕微 肌腱受傷 - 通常輕微, 創傷引致 心臟停頓 血管 - 動脈收縮 神經系統 - 短暫肢体冇力 / 麻木 耳鼻喉 - >50% 耳膜穿破, 短暫失聰 呼吸停頓 - 最普遍死亡原因

44 急救 呼吸或心臟停頓  心肺復甦法 燒傷處理


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